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Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal

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Abstract

Introduction and objectives

Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion.

Methods

After a pretreatment week of tamsulosin 0.4 mg/day (one center only) and following a documented sterile urine, a total of ten patients underwent retrograde holmium laser-assisted endoscopic-guided nephrostomy access in a prone split leg position.

Results

In nine of ten patients, ureteroscopic guided, holmium laser access via an upper pole posterior calyx was achieved. In one patient, the laser tract could not be safely dilated and antegrade endoscopic and fluoroscopic guided access was performed. The mean operative time was 202 min; the mean fluoroscopy time was 32 s (6/9 cases). The mean pre-operative stone volume was 14,420 mm3. CT imaging on post-operative day 1 revealed 6/6 patients had residual stone fragments with total mean volume of 250 mm3 (96% reduction); there were no residual fragments in three patients who were evaluated with non-CT radiographic imaging (KUB). There was a single complication requiring angioembolization due to a subcapsular hematoma with associated secondary tearing of an inter-polar vessel remote from the nephrostomy site.

Conclusions

Holmium laser-assisted endoscopic-guided retrograde access in a prone split-leg position was successfully performed at two institutions. The accuracy of nephrostomy placement and lessening of fluoroscopy time are two potential benefits of this approach.

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Authors and Affiliations

  1. Department of Urology, University of California Irvine (UCI), 333 City Blvd West, Suite 2100, Orange, Irvine, CA, 92868, USA

    Kamaljot S. Kaler, Egor Parkhomenko, Zhamshid Okunohov, Roshan M. Patel, Jaime Landman & Ralph V. Clayman

  2. Department of Urology, Hospital Pablo Tobon Uribe (HPTU), Medellin, Colombia

    Carlos A. Uribe

Authors
  1. Kamaljot S. Kaler
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  2. Egor Parkhomenko
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  3. Zhamshid Okunohov
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  4. Roshan M. Patel
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  5. Jaime Landman
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  6. Ralph V. Clayman
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  7. Carlos A. Uribe
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Correspondence to Kamaljot S. Kaler.

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Kaler, K.S., Parkhomenko, E., Okunohov, Z. et al. Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal. World J Urol 36, 963–969 (2018). https://doi.org/10.1007/s00345-018-2223-9

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  • DOI: https://doi.org/10.1007/s00345-018-2223-9

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